Who would know that a simple question over dinner would lead to an extended exchange of ideas over the Internet. Such is life in the new millennium.

A commenter named Hilary has latched onto the developmental etiology of “Stuttering” and won’t let it go. So … I thought I would bring the topic out of the bowels of “comments” and “revisit” it.

After I responded to one of his/her posts:

“Your article is great but relates to only one of the four potential causes of stuttering”,

Hilary followed with:

“Yes, by the way, the most prevalent. Although the majority of people continues believing that stuttering is mainly psychogenic, it isn’t.”

Quite frankly, I haven’t found any statistics on the prevalence of any of the four causes of “stuttering” to be considered in the differential diagnosis. In review, they are: 1)developemntal, 2)neurogenic, 3)psychogenic and 4)malingering as delineated in the following abstract:

Hilary’s comment that “the majority of people continues believing that stuttering is mainly psychogenic” is a statement that I have found no evidence to support or disprove and can only presume that it is, for what ever reason, simply Hilary’s “assumption” unless Hilary has some data to support it. I, personally, don’t know what the majority of people “believe” about stuttering.

As previously mentioned, I have yet to find any statistical data to delineate the prevalence of any one of the four causes of stuttering. The only references I have found suggesting a numerical weight to any cause are the following statements in various sources:

“Most early childhood or developmental stuttering resolves by the fifth or sixth year of life.”

And, in a Neuroanatomy and Neurology text:

“Stuttering is frequently of psychogenic origin.”

The 70 year old man who has stuttering after a stroke which affected the speech center or speech pathways, doesn’t have stuttering based in “abnormal early childhood development”. Neither does the auto accident victim who suffered massive head trauma and is experiencing new onset stuttering. Both of their etiologies is “neurogenic”.

The shell-shocked war veteran without a history of head trauma who comes home with new onset stuttering has a “psychogenic” etiology.

Also, some children who have persistent stuttering beyond the “normal” time when stuttering usually resolves, can have a “psychogenic” basis for their stuttering which may have nothing to do with a previously existent abnormality of early childhood development. It may have become a maladaptive form of coping.

Obama stutters. When? He stutters when he gets asked questions which are outside of his well polished retinue of “talking points”.

Did he have stuttering as a part of his early childhood development? I don’t know. Could it have been a maladaptive form of coping from stresses of a difficult childhood? Revisit his history, not only the version that he’s presented but what investigators have uncovered. It was Obama who referred to his grandmother as a “typical white person”. That sentiment can cover a lot of territory and rolled off his lips without the slightest hint of stuttering.

I knew a surgeon who did have stuttering which was the result of an abnormality of early childhood development. His stuttering was persistent and at times severe. People did not judge him on his speaking ability but his proven medical knowledge and his extremely experienced and skilled hands.

Barack Obama, to an unusually large degree, is being judged on his oratory skills … alone. When not protected by the podium, he doesn’t do quite as well. The Democratic “debates” were little more that gentle massages for his unchallenged ego.

When confronted with openly hostile questioning, how does Barack Obama handle it? Frequently, he stutters. Hillary Clinton … side steps … when she can. John McCain … attacks.

It’s been an interesting exercise. Standard medical texts such as Beeson and McDermott, Hurst, Conn and Conn as well as Harrison’s neatly jump from staghorn calculi to staphylococcal infections leaving a lot of territory in between unexplored.

When I first heard Barack Obama’s hesitant and repetitive speech, I decided to look up “stuttering” to make sure that’s actually what it was and it seems to fit the definition. I personally thought it was amazing that someone with such touted oratory skills had dysphonic problems. With what little people actually do know about his past, I think the childhood psychiatric etiology is of particular interest. Being familiar with several people who do have stuttering which is of a developmental etiology, I would be more inclined to classify Obama’s stuttering as psychogenic in origin.

I haven’t come across any information which delineates the prevalence of stuttering in the general population much less the prevalence of each of the etiologies to consider in the differential. And, quite frankly, I’m not going to simply take Hilary’s word for it. Neither should you.

Last night while dining with a friend, I was asked the following question, “Where do you think Obama got his speaking ability?”

We were discussing his remarkably polished speaking style which seems to be wooing so many people into his camp and leaving his opponents with, at least, a grudging respect.

Not having really given the question posed any significant thought previously, I was at a loss for an intelligent or thought out response but, after considering what I have read about him, my final response was, “Probably his mother.”

It was a “best guess” under the circumstances. From what I’ve read about his mother, although very sketchy, and given her otherwise unconventional nature, I imagine that she might have possessed the qualities of a good salesman including an adroit and agile command of the English language.

Since last night, I’ve given the question further consideration, mentally reviewing the speeches I’ve heard him give. All are very polished … articulate, well presented … and eloquent … a word I and others have used previously to describe his oratorical or declamatory capabilities.

But …

When outside his prepared and polished realm, he looses his composure. He becomes repetitious and hesitant. He “stutters”. When confronted with questions that he is not prepared to answer or is confronted with topics he appears to be uncomfortable with, he “stutters”.

Stuttering and stammering, what is the difference? More significantly, what causes it?

Stuttering is defined as “the compulsive repetition of certain syllables or words” whereas stammering is defined as “complete blocking of some speech”(1). As noted in the reference, both are almost universally accepted to be psychogenic in origin. Stuttering usually first occurs with emotional tension in the three to six year old child and can be considered a transient normal in children of this age. The reference further states when it persists in the older child, referral to a child psychologist or psychiatrist is recommended, the aid of a speech therapist may be needed and the child’s inadequate confidence will need to be bolstered.

According the the Psychiatry reference(2), children who stutter may have conflicts over passivity and aggressiveness. “Speech is regarded as an aggressive function in which the child may attempt through hesitation to control both himself and the audience. The speech pattern eventually becomes habitual, i.e., persists without constant emotional content, and the stutterer needs speech therapy and psychotherapy for help in resolving the emotional conflicts associated with the disorder.”

I think this raises some interesting questions regarding Barack Obama’s eloquent speeches when well crafted and the onset of his stuttering when confronted with questions for which he is unprepared and those with which he is obviously uncomfortable. It could also be the explanation for his avoidance, in general, of unscripted interviews with reporters, his apparent preference for interviews with perceived “friendly” interrogators and his complete avoidance of perceived hostile situations.

So, is Barack Obama’s eloquent speaking ability one that has come naturally to him or one that is the result of extensive efforts to overcome and mask a speech defect rooted in psychological conflicts and deeply rooted in his childhood? If the latter is the case, how has this shaped his career choices and how he may have carefully crafted his public persona? Would it make any difference in his ability to function effectively as president?